Provider Demographics
NPI:1306865746
Name:MAASSEN, MARTIN J (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:MAASSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 FAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4756
Mailing Address - Country:US
Mailing Address - Phone:765-491-1422
Mailing Address - Fax:765-742-7258
Practice Address - Street 1:1340 FAWN RIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-4756
Practice Address - Country:US
Practice Address - Phone:765-491-1422
Practice Address - Fax:765-742-7258
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025400A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN225210GMedicare PIN
B28806Medicare UPIN